Pneumatosis intestinalis

A 92yearold woman was transferred to our hospital because of diarrhea and vomiting. Approximately 1 month earlier, the patient was admitted to another hospital for the treatment of aspiration pneumonia and pyelonephritis. She had been well with hydration and antibiotics including piperacillintazobactam until 2 days before this presentation, when diarrhea and vomiting developed. On examination, the patient was alert, the body temperature was 37.4°C, the blood pressure was 123/72 mm Hg, and the pulse was 98 beats per minute. The abdomen was flat and tender, with hypoactive bowel sounds, rebound tenderness, and muscular defense. Urine Gram stain showed gramnegative rods. Computed cosmography (CT) of the abdomen without contrast showed a lowdensity linear or bubbly pattern of gas in the bowel wall (Figure 1: A, hepatic level; C, renal level; and E, pelvic level). These uncommon findings on CT images were notable in the lung window setting (B, D, and F at the same level as A, C, and E, respectively). A diagnosis of pneumatosis intestinalis, along with pyelonephritis, was made, and meropenem was administered. Symptoms had gradually improved, and followup CT, performed after a 10day meropenem treatment, showed complete resolution of pneumatosis intestinalis (Figure 1: G and H, renal level). The patient was returned to the first hospital in a stable condition. Causes of pneumatosis intestinalis vary, but the clinical course is considered to be benign in cases without thromboembolism, bowel obstruction, or toxic megacolon,1,2 as seen in our case. The relation between pneumatosis intestinalis and pyelonephritis remains uncertain in the present case.